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Obesity absenteeism

Obese Spanish workers take more sick leave than lean colleagues

The researchers found a consistent association of overweight and obesity with sickness absence due to non-work-related illnesses in both metabolically healthy and unhealthy workers.

The outcomes from the ICARIA (Ibermutuamur CArdiovascular RIsk Assessment) Study, designed to analyse cardiovascular risk factors and their impact on sickness absence in the Spanish working population, has reported obese Spanish workers take more sick leave than their healthy weight colleagues.

"Overall, the working population is supposed to be young and healthy but we have found a high prevalence of cardiovascular risk factors, like tobacco consumption, hypertension, or dyslipidaemia," said Dr Miguel-Angel Sánchez-Chaparro, ICARIA study investigator at University Hospital "Virgen de la Victoria" (IBIMA, University of Málaga, Spain), and Dr Eva Calvo-Bonacho, head of health projects. ICARIA, Ibermutuamur, Spain. "About 6% of Spanish workers are at high cardiovascular risk, i.e. their likelihood of suffering a fatal cardiovascular event during the next ten years is 5% or greater, and they take excess sick leave."

The current study investigated the impact of obesity on sick leave and whether it varied according to being metabolically healthy or metabolically unhealthy.

The study included 174,329 healthy workers who were classified by BMI and metabolically healthy/unhealthy. Workers were classified as metabolically unhealthy if they had three or more of the following criteria: high waist circumference; raised triglycerides or receiving treatment for hyperlipidaemia; low HDL (high-density lipoprotein) cholesterol; high blood pressure or previous diagnosis of hypertension or receiving treatment for hypertension; or high fasting glucose or receiving treatment for diabetes.

Data on sickness absence during a one-year follow-up period was obtained from the Mutual Insurance Company (Ibermutuamur) registers. Episodes of sick leave were divided into non-work-related diseases and accidents and work-related diseases and accidents.

The researchers analysed the association of BMI range (<18.5, 18.5 to 24.9, 25 to 29.9, 30 to 34.9, 35 to 39.9, >40) and metabolic phenotype with sickness absence.

The average age of employees was 41 years, 67% were men, and 49% did manual work. The proportions with overweight, obesity and metabolically unhealthy phenotype were 38%, 16% and 10%, respectively.

The researchers found a consistent association of overweight and obesity with sickness absence due to non-work-related illnesses in both metabolically healthy and unhealthy workers. After adjusting for sex, age and occupation, metabolically healthy overweight/obese people were 37% more likely to take sick leave and metabolically unhealthy overweight/obese people were 71% more likely to take sick leave than people who were not overweight/obese.

"Our results show that overweight and obese workers are more likely to take sick leave for non-work-related illnesses, regardless of whether they are metabolically healthy or unhealthy," said Dr Sánchez-Chaparro and Dr Calvo-Bonacho. "The increase in sickness absence and associated productivity losses add to the pervasive consequences of obesity which is already a major public health concern."

In the case of work-related sickness absence, the risk of suffering occupational injuries was higher in workers with a BMI35-39.9 and metabolically healthy. Risk was lower among those with BMI40kg and metabolically healthy, and in all metabolically unhealthy individuals regardless of BMI.

Dr Sánchez-Chaparro and Dr Calvo-Bonacho said: "In the case of work-related sickness absence, our results suggest that obesity and the metabolically unhealthy phenotype could be linked with a kind of exclusion from professions and activity sectors that involve more physically active jobs and are thereafter riskier from the point of view of occupational injuries."

They concluded: "Our results highlight the need to develop effective interventions aimed at decreasing the negative impact of the obesity epidemic among the working population. Metabolically healthy workers who are overweight or at the mildest range of obesity progression may be an appropriate target group in whom to implement lifestyle modification initiatives to reduce the likelihood of transition to an impaired metabolic phenotype." 

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